Endocrine Abstracts

Background: Polycystic ovary syndrome (PCOS) affects 5–10% of women in the reproductive age group. It is associated with insulin resistance and hyperinsulinemia which is further aggravated during pregnancy. The use of metformin in PCOS is increasingly accepted but its therapeutic use during pregnancy is still a debatable issue. There are few local studies on the use of metformin among PCOS patients and data are lacking among Filipinos.

Objectives: To determine the effect of metformin on maternal and neonatal outcome among pregnant Filipino women with PCOS.

Design: Cohort study

• Setting: Review of outpatient medical records at a private infertility clinic

• Population of interest: pregnant PCOS patients conceived with metformin

• Pregnancy outcome measures: Maternal outcome – rate of first trimester spontaneous abortion, development of gestational diabetes, pregnancy-induced hypertension, mode of delivery and gestational age of delivery. Neonatal outcome – live birth rates, APGAR score, infants birth weight and development of congenital anomaly.

Results: Pregnant women who continued metformin during pregnancy had lower rate of first trimester spontaneous abortion (5 vs 36.2%, P value <0.001). A nonsignificant decrease in gestational diabetes was observed among PCOS women who continued metformin throughout pregnancy (19.0 vs 32.6%, P value 0.07). No pregnancy-induced hypertension was found between the two groups. There were no differences with regard to modes of delivery and gestational age of delivery ((NSVD 44.6 vs 47.4%; CS 55.4 vs 52.6%, P value 0.77) (preterm 9.8 vs 2.7%; term 89.1 vs 97.3%; post-term 1.1 vs 0, P value 0.317)). Using multiple logistic regression, only metformin during pregnancy was significantly related with spontaneous abortion (OR=0.168, 95% CI 0.048–0.592, P value 0.005). The differences in neonatal outcomes between the two groups did not achieve statistical significance.

Conclusion: In women with PCOS, continuous use of metformin during pregnancy reduced the rate of first trimester spontaneous abortion.